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Nemo
31-08-2008, 10:18 AM
I recently posted asking for advice on crown options, but now want to ask if anyone (Toothsmith etc.?) have any thoughts on further diagnosis or the cost question I'll ask at the end.

About a year ago I went to have a large filling redone on my lower right 6 (I think that's what it's called). It hadn't been causing any problems, but she obviously saw something that needed treatment. I can remember her putting various potions in the prepared cavity, and seem to recall her saying about using something other than amalgam, though not 100% about this.

The tooth never seemed to settle down, no pain but I was just aware of the tooth if this makes any sense. I thought I could feel small crack down the middle on the inside of the tooth, but didn't know if I was only feeling something that was already there due to a scale and polish.

A couple of months ago though I started getting discomfort/mild pain when biting hard food. I explained all the symptoms to the dentist, and answered her question regarding sensitivity to hot and cold by saying this wasn't a problem. She checked the bite with the bit of paper thing, and smoothed a raised bit of tooth off. She took x-rays of the tooth saying it could be an abscess and that I might need a root canal depending on what showed up.

When I went back she said that the x-rays were absolutlely fine, and that it could all be caused by the crack so she'd do a crown, which is where my last thread left off.

Anywho, I went to have the crown prep done a couple of days ago. She said "We're doing a crown to cure the problem you're having with hot and cold". I told her that it was biting problems I was actually having. She said "We might have to reassess in that case". I had made it totally clear of my symptoms. She carefully rechecked the x-rays which again didn't show anything. She decided to do a crown prep with a temporary crown, then I have to phone up 4 days later to let her know if the problem seems to have gone so she can get the crown produced.

I can already tell it's no better, in fact if anything feels a little worse. By way of symptoms, the discomfort is when pressure is applied to the top of the tooth towards the back. There's no discomfort if I grip the tooth by the sides and press down, and there's no discomfort when there's no pressure applied at all, only when eating (or poking!).

Any thoughts on the diagnosis?

Secondly, I'd previously decided to have a private gold crown done at £380. If it's decided that I need a root canal, or some other work, can I at this stage ask to revert to NHS treatment and have whatever's needed, including an NHS crown for the maximum NHS cost (£198?) ? I can envisage this climbing up towards £1000 otherwise. Oh, and would it cause difficulties doing a root canal on a crown-prep'd tooth?

Sorry this was a longer post than envisaged. Well done if you got this far.

Thanks in advance.

alison999
31-08-2008, 10:39 AM
If the crown hasnt been made yet you should be able to switch back to NHS £198 I would have thought, but that is up to the dentist. She may feel she spent more time prepping the tooth, believing she would be charging you privately for it. I dont think theres any 'rules' regarding that.

As for hot & cold, im not a dentist, but i think thats usually something to do with rct. toothsmith will probably be able to tell you all that.... but if it is needed and she will do it nhs for you it'll be included in the £198. However, its very unusual for a nhs dentist to do rct on the nhs on a molar tooth.

Toothsmith
31-08-2008, 11:45 AM
It is a very tricky one this!

I think your dentist is right to proceed cautiously with it and I think she's covering the bases well.

There will be no problem root filling a prepped tooth - and it's much better than having to drill a hole in your nice new crown.

There's always the possibility that the small crack is right through the tooth, in which case, there's not much hope for the tooth (even though it's not giving many symptoms at the moment). This sort of thing is a real pig to treat sometimes - everything you do just seems to make the tooth worse and worse.

It's quite right to treat it - you can't just ignore these things, but it can seem wrong to the patient to start out with a tooth giving mild discomfort, and end up with a lot of work, or loosing the tooth.

As I said earlier, your dentist seems to be doing everything right, and she's in a far better position than me to judge what should be done.

As to the NHS/private bit, you'll need to discuss that with her.